Autonomía en la gestión hospitalaria en Chile: los desafíos para el recurso humano en salud

Abstract

In Latin America, some health sector reforms have included steps to the implementation of autonomous hospitals. In Chile, the health system is implementing a reform that introduces a network of self-managed institutions. These organizations will be high complexity centers that involve greater technical diversity, cost centers and mechanisms to evaluate users' satisfaction. For human resources in health, the implementation of these centers creates challenges in the planning of service provision and a change from the traditional management style of the teams to one based on networks. These challenges include the estimation of gaps in medical specialists and in other professions in the health sector. In order to be successful with self-management, Chile needs to establish universal and local policies that address training and the organization of health service provisioning in these institutions. The health systems reform implemented over recent decades in Latin America included changes to separate the functions of fi nancers and providers, granting of rights to health care services, implementation of health insurance, increasing coverage, changes to human resources policies and implementation of new management models. 16 Moreover, the performance of management duties 20 and the decentralization of services 29 were strengthened. The implementation of the administrative changes was done at a mid-and low-level of the systems.12 These modifi cations were translated into restructuring processes and not into greater autonomization in the management of hospital services and institutions. 12In regards to human resources in health, the reforms on the continent introduced changes that favored greater productivity, performance evaluations, implementation of incentive systems and new types of contracting. 6 Nonetheless, the inequity in its distribution, the concentration of specialties, the increase of professional migration and the fl exibility of employment contracts, continue to constitute areas in need of more regulation.

Desafíos de la Red Asistencial Pública de Chile en la Especialidad de Trastornos Temporomandibulares y Dolor Orofacial

“…Este sistema de salud debe poseer un enfoque estratégico que implica la presencia de una cartera de prestaciones y especialidades ajustada a las demandas de salud de la población lo cual es fundamental para el desarrollo estratégico de la red asistencial. La creación del recurso humano en salud y su funcionamiento en red, debe basarse en la evidencia científica epidemiológica disponible lo que es un insumo necesario para la estimación de brechas de especialidades médicas y odontológicas (Méndez & Torres, 2010).…”

Implementing Hospital Self-Management Policy in Chile: Health Professionals’ Perceptions

“…The lack of a human resources policy to accompany changes in hospital organizations was noted as a crucial gap between design and implementation (22,38,39). However, the results show that nine years after the promulgation of the reform laws, this continues to be one of the determining factors for the performance of the teams and health institutions.…”

Política de autogestión hospitalaria en Chile: percepciones de los tomadores de decisiones

“…Un hallazgo relevante fue que los tomadores de decisiones percibieron la ausencia de una política de recursos humanos alineada con las exigencias organizacionales y clínicas de la imple mentación de la política. La falta de una política de recursos humanos fue ad vertida como una brecha determinante entre el diseño y la implementación de la reforma de la salud y de la política de autogestión hospitalaria (15,18,(33)(34)(35). A siete años de la promulgación de la reforma, todavía no se han evidenciado progresos estructurales.…”